Op-ed: Adherence deserves historic collaboration

I took an opportunity at the 2009 NACDS Annual Meeting to reflect on words spoken 70 years earlier by then-NACDS president Nate Shapero of Cunningham Drug Stores. His words at the second annual convention of NACDS, on May 5, 1939, could have been delivered today: “At our first annual convention last year, I sounded the keynote of the ‘Triumph of Cooperation’ … our association … is an effective instrument for the elimination of the evils in our industry, and for the development of a sound relationship between the manufacturer … the producer … the chain store … and between ourselves and the public.”

If there is any doubt that there are challenges that need to be overcome, and that there is a need for collaboration, just consider the attacks that are levied against pharmacy and pharmaceutical suppliers. There are those who say that pharmacists perform only a dispensing function. About manufacturers, some remain fixated in their rhetoric on what they call the high price of prescription drugs, without any context related to research costs, the public benefit and the costs avoided by treatment of chronic disease.

It just may be that the concept of adherence is the bridge to greater understanding among policy-makers and the public of the dual value of pharmacy and pharmaceuticals. As this understanding increases, so will the appreciation of pharmacists, pharmacies and medications.

Medications are important to the management of chronic diseases that require long-term or lifelong therapy. Pharmacists are uniquely qualified as medication experts to work with patients to manage their medications and chronic conditions, and play a key role in helping patients take their medications as prescribed.

Nonadherence with medications is a significant problem. According to a report by the World Health Organization, in developed countries only 50% of patients with chronic diseases adhere to medication therapies. In the United States, failure to take medications as prescribed has been estimated to impose more than $177 billion dollars annually in direct and indirect costs. Poor adherence leads to unnecessary disease progression, reduced functional status, more extensive and more expensive medical care, a lower quality of life and premature death.

Studies have demonstrated that pharmacist-provided medication therapy management services can help. In one frequently cited study, every $1 invested in MTM services reduced overall healthcare costs by more than $12. We must spread the news about this opportunity to reduce healthcare costs, while improving patient care and quality of life.

This is why NACDS is working with allied organizations for enhancement of the MTM benefit in Medicare Part D. That also is why the NACDS Foundation is supporting educational initiatives, along with the Pharmaceutical Research and Manufacturers of America, that are designed to enhance the public understanding of factors affecting medication adherence. 

Together, we must boost appreciation for the value that comes from proper utilization of prescription drugs. During the current healthcare reform debate, NACDS has a lot to offer as a retail association. We can make a personal and credible pitch for the overall benefits of the kinds of products and services for which suppliers are responsible. By definition, pharmacies and pharmacists are the segment of the supply chain that is closest to the people.

In last year’s Gallup survey that measured the public’s perception of professional integrity, pharmacists came in second, right behind nurses. Pharmacists have been in the top three each of the past six years. Our industry is blessed with ideal ambassadors for mutual issues of importance, which directly affect the well-being of patients and the entire healthcare system.

Nate Shapero was on to something when he spoke in 1939 about NACDS’ ability to leverage productive relationships. He did not live in Utopia any more than we do. He was a businessman — struggling with economic turmoil, competition, business relationships and responsibilities to view his world broadly, at the helm of an industry association. But these factors did not delay, derail or deny the vision and pursuit of a common purpose. That is a concept that must not be lost on us today.

On behalf of NACDS, we look forward to working with you, for the ultimate good of the patients we serve.